Gender disparities in clozapine prescription in a cohort of treatment-resistant schizophrenia in the South London and Maudsley case register

Wesley, Emma; Patel, India; Kadra-Scalzo, Giouliana; Pritchard, Megan; Shetty, Hitesh; Broadbent, Matthew; Segev, Aviv; Patel, Rashmi; Downs, Johnny; MacCabe, James H.; Hayes, Richard D.; Freitas, Daniela Fonseca de

doi:10.1016/j.schres.2021.05.006

Cited by 21 publications

(12 citation statements)

References 51 publications

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“…In a recent publication, Wellesley et al . (Wellesley et al ., 2021) also found that women with treatment resistant schizophrenia (TRS) are less likely to be prescribed clozapine than men. Considering the effectiveness of treatment with clozapine, this bias may place women with TRS at higher risk for hospitalization, mortality, and poorer quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…However, we did not assess whether cases included in our analyses were treatment resistant or not and accordingly, the issue of potential gender differences in the prescription of clozapine cannot be answered by our data. In a recent publication, Wellesley et al (Wellesley et al, 2021) also found that women with treatment resistant schizophrenia (TRS) are less likely to be prescribed clozapine than men. Considering the effectiveness of treatment with clozapine, this bias may place women with TRS at higher risk for hospitalization, mortality, and poorer quality of life.…”

Section: Discussionmentioning

confidence: 99%

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No gender differences in the pharmacological emergency treatment of schizophrenia: results of a 21-year observation

Edlinger,

Brettbacher,

Schurr

et al. 2023

International Clinical Psychopharmacology

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Patients suffering from schizophrenia are at high risk for admission and treatment in locked units. This study investigated gender differences in the pharmacological emergency treatment of schizophrenia patients over a 21-year observation period. The current retrospective study was conducted at the Division of Psychiatry I of the Medical University Innsbruck. All adult patients (n = 845; 425 female) suffering from schizophrenia who were admitted involuntarily to one of the acute psychiatric units in the years 1997, 2002, 2007, 2012 and 2017 were included in the study. In the years mentioned above, 590 schizophrenia patients (297 men, 293 women) admitted to a locked unit received pharmacological emergency treatment. With the exception of clozapine which was more frequently administered to men no significant differences between men and women were found in terms of the choice, dosage, and type of application of medication (antipsychotics and benzodiazepines). Since most treatment guidelines for schizophrenia do not consider gender differences at all, it is not surprising that acute treatment is almost the same for men and women. However, in times when individualized therapies gain more and more importance, the consideration of sex differences should be part of new treatment concepts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

No gender differences in the pharmacological emergency treatment of schizophrenia: results of a 21-year observation

Edlinger,

Brettbacher,

Schurr

et al. 2023

International Clinical Psychopharmacology

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“…Observed disparities in antipsychotic prescribing by ethnicity may not only reflect the variation in biological sensitivities (e.g., different metabolic capacities across racial groups) to antipsychotic medications, but also the role of cultural factors in shaping expectations and response to treatments ( Das-Munshi et al, 2018 ; Taylor, 2004 ; Bhugra and Bhui, 1999 ). In addition to demographic and clinical factors that have been widely studied in the literature ( Das-Munshi et al, 2018 ; Connolly et al, 2007 ; Copeland et al, 2003 ; Wesley et al, 2021 ), our models were also adjusted for neighbourhood own-group ethnic density which to some extent reflects individuals' attachment towards to their cultures or ethnic identity ( Stronks et al, 2013 ), as ethnic minorities living in areas with a higher own-group ethnic density may be more oriented towards their cultures of origin ( Termorshuizen et al, 2018 ). Our results suggested that overall ethnic group density might act as an important mediator in linking ethnicity and antipsychotic prescribing.…”

Section: Discussionmentioning

confidence: 99%

Unraveling ethnic disparities in antipsychotic prescribing among patients with psychosis: A retrospective cohort study based on electronic clinical records

Wang,

Codling,

Bhugra

et al. 2023

Schizophrenia Research

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“…Despite the overwhelmingly favorable evidence, which is reflected in unanimous guideline recommendations [49 ▪▪ ], clozapine remains severely underused across industrialized countries [5,50 ▪ ,51 ▪ ] with underutilization apparently most pronounced in female TRS patients [52 ▪ ]. There are notable differences between and within countries, which might offer important clues for the underlying causes.…”

Section: Clozapine Underutilizationmentioning

confidence: 99%

The ever-growing case for clozapine in the treatment of schizophrenia: an obligation for psychiatrists and psychiatry

Bittner

Reif

Qubad

2023

Current Opinion in Psychiatry

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Purpose of reviewClozapine remains the gold standard for treatment-resistant schizophrenia (TRS). Although the evidence base for its wide-ranging, unique efficacy continues to expand, clozapine remains alarmingly underutilized in industrialized countries. Analyzing the causes and consequences of this problem is crucial for substantially improving the quality of care for TRS patients.Recent findingsClozapine is the most effective antipsychotic for reducing all-cause mortality in TRS. In most cases, treatment resistance emerges during the first psychotic episode. Delaying clozapine treatment has a negative impact on long-term outcome. Patients’ experience with clozapine treatment is largely positive despite a comparatively high rate of side effects. Patients prefer clozapine, while psychiatrists regard it as a burden due to concerns regarding safety and side effect management. Shared decision-making (SDM), which increases the likelihood of a clozapine recommendation, is not routinely used, possibly due to stigmatization of TRS patients.SummaryThe mortality-reducing effects of clozapine alone warrant its regular use. Therefore, psychiatrists must not exclude patients from the decision regarding a clozapine trial by not even offering it. Rather, they have a clear obligation to align their actions more closely with the existing evidence and patients’ needs and to facilitate the timely initiation of clozapine.

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Gender disparities in clozapine prescription in a cohort of treatment-resistant schizophrenia in the South London and Maudsley case register

Cited by 21 publications

References 51 publications

No gender differences in the pharmacological emergency treatment of schizophrenia: results of a 21-year observation

No gender differences in the pharmacological emergency treatment of schizophrenia: results of a 21-year observation

Unraveling ethnic disparities in antipsychotic prescribing among patients with psychosis: A retrospective cohort study based on electronic clinical records

The ever-growing case for clozapine in the treatment of schizophrenia: an obligation for psychiatrists and psychiatry

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